Implementation of pharmacist-led direct oral anticoagulant candidate screening process within current anticoagulation clinic Jessica Holleman, Emily Jolly, Paul Butts Fayetteville VA Medical Center - Fayetteville, NC
Background/Purpose: At this institution, patients prescribed warfarin for the prevention of stroke in atrial fibrillation are managed by a Clinical Pharmacy Specialist (CPS) in the anticoagulation clinic. Patients prescribed a direct oral anticoagulant (DOAC) for the same indication are followed by a CPS within the Patient Aligned Care Team. A screening tool was developed to identify appropriate candidates to switch from warfarin to DOAC therapy. The purpose of this quality improvement project was to determine the impact of a screening tool on the average number of monthly clinic encounters within the anticoagulation clinic.
Methodology: The number of average monthly clinic encounters for three months prior to and two months after the eight-week screening period, conducted from August _x0013_ September 2018, was compared to determine the impact of the screening tool. The screening tool was developed based on Veterans Affairs Pharmacy Benefits Management Service Criteria for Use. Eligible patients were counseled on DOACs and given the opportunity to switch therapies. The total number of patients who chose to switch and the total number of encounters associated with these patients before and after the screening period were recorded.
Results: On average, seventy additional monthly encounters were observed after screening tool implementation (p= 0.15). Thirty patients chose to switch to DOAC therapy and there was a reduction of seventy-five total encounters after screening (p= 0.01).
Conclusions: The screening tool did not impact the average number of monthly clinic encounters; however, it was clinically and statistically significant in reducing the number of individual encounters associated with patients who elected to switch from warfarin to DOAC therapy.
Presentation Objective: Identify areas where a screening tool to convert patients from warfarin to DOAC therapy may be effective.
Self-Assessment: In what ways can a screening tool for conversion from warfarin to DOAC therapy positively impact an anticoagulation clinic?
